Should I consider TRT?

[fibispiral112]

I've been having a lot of the symptoms of low testosterone. I had a discount to try the Advanced Male Hormone Panel from a company called Let's Get Checked, so I decided to give it a shot.

Testosterone 19.3 nmol/L
SHBG 44.0 nmol/L
Free Androgen Index 43.9
Prolactin 616.0 (high)
Oestradiol 47.0 pmol/L

I'm going to be 32 in December, but I've had noticable symptoms of low T since I was 25 (weak erections, no libido, fatigue, unable to focus, etc.)

My PCP tested my hormones a few years ago, and told me everything was fine and put me on an SSRI (which did nothing for my symptoms. )

I work at a stressful job and have been trying to supplement with vitamins to support my adrenals. I've lifted weights on and off for about 10 years but have hardly been able to put on muscle.

I've tried SSRIs but I've never been able to overcome the overwhelming fatigue and apathy I feel almost every day.

I was looking into Defy medical, but I really don't want to spend the extra money if my labs don't justify treatment.

Any thoughts?

 

[Systemlord]

This is typical of western medicine doctors, drugs are whats in the toolbox and what there are trained to prescribe and doctors stick with what they know best.

Your TT while decent isn't the active hormone, the FT is the active portion of testosterone and the only one that matters.

Your FT using the Tru-T calculator considering your TT and SHBG levels is 17.50 (ranges 16-31) is on the lower end due in part to your slightly elevated SHBG and/or rate at which you metabolize testosterone. SHBG is a protein made in the liver, it binds testosterone.

Lowering SHBG naturally is next to impossible, sure you might lower it a little, but probably not enough and as you age SHBG increased so the time is not on your side.

In your case your SHBG is binding up of good portion of your testosterone lowering FT. Your prolactin is high and can lower testosterone, we would need to see where LH sits since it is the stimulating hormone for the testicles which then produces testosterone.

Prolactin may or may not be responsible for a decrease in testosterone, but an MRI is needed to look for prolactin releasing pituitary tumors.

It wouldn't hurt to order a thyroid panel, low thyroid hormones (fT3/high rT3) can increase prolactin.

 

[Cataceous]

... do in part ...
... SHBG ... binds ... thyroid hormones and insulin.
...

A very good post overall. I'll nitpick by mentioning that SHBG is not considered a carrier of insulin or thyroid hormones. Also, "do" should not used in place of "due".

 

[Vince Carter]

Prolactin may or may not be responsible for a decrease in testosterone, but an MRI is needed to look for prolactin releasing pituitary tumors.

It wouldn't hurt to order a thyroid panel, low thyroid hormones (fT3/high rT3) can increase prolactin.

I agree, MRI on the Pituitary, or atleast a PRL retest is in order. Also on Thyroid:

TSH
Free T4
Free T3
Reverse T3
Antibodies

Id rather see you delve in to those before TRT.

 

[Vince Carter]

Also, "do" should not used in place of "due".

Please go find something else to occupy your time.

 

[Cataceous]

Please go find something else to occupy your time.

Says the pot to the kettle.

 

[fibispiral112]

So, I had more blood work done, and I'm not sure what to think.

Total Testosterone increased to 606 ng/dL
Free Test 13.6 pg/mL
DHT 60 ng/dL
Free T4 (direct) 1.47 ng/dL
DHEA-S 181.7 ug/dL
TSH 2.27 uIU/mL
LH 4.6
Prolactin 15.8 ng/mL
Reverse T3 22.9 ng/dL
Estradiol 11 pg/mL
Free T3 3.6 pg/mL
SHBG 46.5 nmol/L
Thyroglobulin Antibody <1.0 IU/mL

Everything seems normal (?)

I'm really not sure what to think. Could symptoms be due to low Free T? I'm not sure what direction to take, other than seeing if my doctor would be willing to do an MRI for a possible pituitary tumor, but he says that it's not something that he's concerned about.

 

[Cataceous]

This time free testosterone calculated via Tru-T is about 19 ng/dL (16-31), so not extremely low, but possibly contributing to symptoms. Prolactin is still a little elevated. Most notable is the high-in-range reverse T3. I had a similar reading and opted to try low doses of T3 (5-10 mcg per day). This drove down rT3 and really helped to reduce fatigue symptoms.

 

[Systemlord]

I was able to reduce rT3 on TRT by improved diet and working out. The Tru-T calculator has your FT closer to the bottom end on the range. It's common to see men with symptoms of low testosterone with TT above midrange and SHBG on the higher end.

I don't think it's complicated, it's pretty clear FT is suboptimal. Low testosterone men who are placed on SSRI's usually report symptoms persist, that's because these drugs didn't address the suboptimal FT levels.

 

[fibispiral112]

I was able to reduce rT3 on TRT by improved diet and working out. The Tru-T calculator has your FT closer to the bottom end on the range. It's common to see men with symptoms of low testosterone with TT above midrange and SHBG on the higher end.

I don't think it's complicated, it's pretty clear FT is suboptimal. Low testosterone men who are placed on SSRI's usually report symptoms persist, that's because these drugs didn't address the suboptimal FT levels.

Is there anything I can do to naturally increase free T? I lift weights 4 to 5 days out of the week, cardio 2 to 3 days (usually), and I tend to eat pretty clean. I know there isn't much a person can do to decrease SHBG.

 

[Systemlord]

Is there anything I can do to naturally increase free T? I lift weights 4 to 5 days out of the week, cardio 2 to 3 days (usually), and I tend to eat pretty clean. I know there isn't much a person can do to decrease SHBG.

Your SHBG is going to bind up any significant increase in testosterone, FT will always be suboptimal.

You'll never get FT to the optimal range as long as SHBG is on the higher end. SHBG is not something you have much control over, it goes wherever it wants.

 

[swoops36]

E2 of 11 with higher SHBG? That could be part of the problem ... try something to raise that up?

 

[fibispiral112]

Your SHBG is going to bind up any significant increase in testosterone, FT will always be suboptimal.

You'll never get FT to the optimal range as long as SHBG is on the higher end. SHBG is not something you have much control over, it goes wherever it wants.

Even if I were to go on TRT? Levels would continue to remain suboptimal?

 

[Systemlord]

Even if I were to go on TRT? Levels would continue to remain suboptimal?

TRT will decrease your SHBG probably by half therefore increasing FT levels, you can increase FT levels to your heart's content. Testosterone cypionate creates unnatural spikes in testosterone which will lower SHBG in just about everyone.

 

[Vince Carter]

Even if I were to go on TRT? Levels would continue to remain suboptimal?

That's not true, SystemLord is saying the basic correct thing but as absolute it's not true that a high SHBG guy cannot achieve a good level of FT.
The typical course of action is one injection per week of a large dose, this can in some situations push SHBG lower to an unknown extent it might be a few points or 10 points...no one knows. But the end game with high SHBG is that you'll have to run a higher Total T in order to overcome the SHBG. You may just have to run a TT that is 1000-1200, or more before Free T comes up.